Hackensack University Medical Center

Instructions:

Hackensack University Medical Center

and the

24th District, EMS Council of NJ

2019 Scholarship Application Robert D. Cirri Memorial Scholarship Emil Yannetti Memorial Scholarship William DeLooper Memorial Scholarship Walter L. Friedrichs Memorial Scholarship Mary and Edward Ehrenberg Memorial Scholarship

Please read the accompanying requirements for each scholarship and submit all necessary documentation all together with your application. Please check off below on left which scholarship you qualify for and are applying. The Scholarship Committee has the final determination in awarding the scholarships. Recipients of scholarships must attend the HackensackUMC EMS Awards presentation dinner to receive their scholarship. You should download the entire application from this web site. Your scholarship award will be issued to you upon receipt of your fall 2019 tuition statement. All parts of the scholarship must be mailed certified/return receipt requested and post marked no later than April 20, 2019. Applications should be mailed to Mr. Chuck Parodi, 48 West Grove Avenue, Maywood, New Jersey 076071548. Any further inquiries can be answered by calling 201-843-6966.

Check off below which scholarships you are applying for and follow accompanying directions: _______ Robert D. Cirri Memorial Scholarship

Applicants may be a graduating high school senior or presently attending a college or vocational school. The applicant must be an EMT certified riding member of an EMS squad or child of an EMT certified riding member of an EMS squad. Two letters of recommendation are required. One letter should be from the captain of the EMS squad for which you or your parent are a member. The second letter must be from a high school or college teacher you had as an instructor. Letters must be signed by recommending person and include an address and telephone number where they can be reached. You must include your high school transcript, and if graduated from high school, a transcript of present institution of higher learning you are attending. A copy of your EMT card must be included and if applying as a child of an EMT, the parent's EMT card. Complete and include essay #1, #2 or #3 of application on separate piece of paper.

_______ Emil Yannetti Memorial Scholarship

This scholarship is open ONLY to persons whose squad is a member of the 24th District, NJSFAC. The requirements are the same as listed above for the Robert D. Cirri Memorial Scholarship.

_______ William DeLooper Memorial Scholarship

This scholarship is sponsored and given by VCI Emergency Vehicles Specialists of Berlin, New Jersey. This scholarship is open to all persons whose squads are members in good standing with the NJSFAC. Those applicants for this scholarship should follow the requirements listed under the above Robert D. Cirri Memorial Scholarship.

_______ Walter L. Friedrichs Memorial Scholarship

This scholarship is sponsored and given by V.E. Ralph Emergency Medical Products of Kearny, New Jersey. This scholarship is open to all persons whose squads are members in good standing with the NJSFAC. Those applicants for this scholarship should follow the requirements listed under the above Robert D. Cirri Memorial Scholarship.

_______ Mary and Edward Ehrenberg Memorial Scholarship

This scholarship is sponsored and given in memory of Mary and Edward Ehrenberg of Paramus, New Jersey by their daughter Irene A. Fortunato and grandson, Edward P. Abramov. Longtime residents of Paramus, NJ, they collectively lived 180 years and in later life depended heavily on their town's EMS services. Preference will be given to applicants who are members of the Paramus Volunteer Ambulance Corps or Paramus Emergency Medical Services followed by neighboring EMS Council of New Jersey squads. This scholarship is open to all persons whose squads are members in good standing with the NJSFAC. Those applicants for this scholarship should follow the requirements listed under the above Robert D. Cirri Memorial Scholarship.

Complete the following (type or print neatly)

Name of applicant _____________________________________________________________________________

(last)

(first)

(middle)

Home address ____________________________________________________________________________________ (number & street)

Home phone ______________________ Cell phone _____________________________

Date of birth ______________________

Name of high school attended _______________________________________________________________________

Include with application a copy of your high school transcript that includes senior year classes, SAT or ACT scores, GPA, and class ranking. If already in an institute of higher learning, please also include a transcript from this school.

Father's name _______________________________________________ Occupation _________________________________ Mother's name ______________________________________________ Occupation _________________________________ Parent's marital status: ___________ married _________ divorced __________ separated List brothers and sisters supported by your parents:

Name

Age

Relationship

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

List school activities. Include such activities as clubs, athletics, class office held, etc. Indicate what years participated and advisor's name for each activity.

ACTIVITY

POSITION HELD

YEARS

ADVISOR'S NAME

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

List community activities. Include such activities as scouting, church organization, service activities, etc

EMPLOYER

POSITION HELD

YEARS

SUPERVISOR'S NAME

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

List work experiences.

EMPLOYER

POSITION HELD

YEARS

SUPERVISOR'S NAME

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

List special awards/ recognition you have received:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

What course of study do you plan to take in college?

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

List the college/universities (in order of preference) to which you have applied:

College/university

Tuition per year

Room & Board per year

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Applicant's ambulance squad service/training: Name of squad: ____________________________________________________________ Length of service on squad:____________ years ________ months Training certification: attach a copy of applicant's EMT and CPR certification Please list any positions held or recognition given to you by your squad: _________________________________________________________________________________________________ _________________________________________________________________________________________________

Parent of applicant's ambulance squad affiliation (if applicable):

Name of squad of which parent is an active member:____________________________ Parent's length of service on squad: ______________ years __________months Attach copy of parent's current EMT certification. List any position held by parent in their respective squad and/or NJSFAC: _________________________________________________________________________________________________ _________________________________________________________________________________________________

Essay: Answer any one of the following statements in a well-written essay format: Essay #1 Explain why you joined an EMS squad and how it has affected you in terms of attitude, responsibility, maturity, and selfesteem. Essay #2 List three problems facing most EMS squads in New Jersey today. After identifying these problems, realistically give possible solutions in how you would address these problems. Essay #3 After discussing with your parent why he/she joined their respective squad, write an essay on how being an EMT has affected his/her life. Include both the positive and negative aspects that come with membership

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